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General NPI Number Information
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NPI Number | 1184946220
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Entity Type | Individual
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Provider Name | HAZEL AGATHA ANTHONY P.T
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Gender | Female
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Dates
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Enumeration Date | 02/16/2010
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 7520 ASTORIA BLVD
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City | EAST ELMHURST
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State | NY
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Zip | 11370-1138
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Country | US
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Telephone | 718-888-6924
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Fax |
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Provider Business Mailing Address
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Address Line | 24302 134TH AVE
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City | ROSEDALE
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State | NY
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Zip | 11422-1424
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Country | US
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Telephone | 718-276-6880
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 014053-1
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License Number State | NY
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